同轴1.8mm微切口超声乳化白内障手术临床效果评价

目的 观察同轴1.8mm微切口超声乳化白内障手术的临床效果,并与传统同轴3.0mm小切口超声乳化手术进行比较.方法 前瞻性随机对照研究.采用随机数字表法,将实施超声乳化白内障手术的年龄相关性白内障患者89例(89只眼)随机分为2组.微切口组:同轴1.8mm微切口超声乳化白内障吸除联合人工晶状体植入手术45例(45只眼);小切口组:传统同轴3.0mm小切口超声乳化白内障吸除联合人工晶状体植入术44例(44只眼).取随访资料完整者,微切口组40例(40只眼),小切口组40例(40只眼)进行分析.分别记录两组超声乳化所用的平均超声能量(AVE)和有效超声时间(EPT),术后1d、1周、1个月和3个月随访,检查并记录视力、角膜内皮密度、中央角膜厚度,手术源性散光.采用两均数t检验和x2检验对数据进行统计学分析.结果 两组所用EPT和AVE差异无统计学意义(t=-0.149,P=0.882;t=-0.769,P=0.444).术后1d,微切口组裸眼LogMAR视力0.16±0.14优于小切口组0.23±0.12,且差异具有统计学意义(t=-2.371,P=0.020).术后1周、1个月和3个月,两组矫正视力差异均无统计学意义(t=-1.469,-1.437,-1.585;P=0.146,0.155,0.117).术后1d、1周、1个月和3个月,两组角膜内皮细胞密度及中央角膜增厚程度改变差异无统计学意义(P＞0.05).术后1d、1周、1个月及3个月,同轴微切口组手术源性散光分别为(0.62±0.28)D,(0.48±0.28)D,(0.47±0.25)D,(0.40±0.24)D;同轴小切口组手术源性散光分别为(1.27±0.65)D,(1.18±0.59)D,(1.02±0.56)D,(0.79±0.48)D,两组间差异具有统计学意义(t=-5.940,-7.247,-5.779,-4.788;P =0.000,0.000,0.000,0.000).微切口组手术源性散光于1周后明显下降(t=2.517,P=0.014)并趋于稳定,小切口组手术源性散光则于术后1个月出现明显下降(t =2.105,P=0.038).结论 同轴1.8mm微切口与传统的同轴3.0mm小切口超声乳化白内障手术相比,能有效减少手术源性散光,且散光状态更早稳定,对术后视力早期恢复具有优势.

Clinical evaluation on the coaxial 1.8 mm microincision cataract surgery

Objective To study and compare the outcomes of coaxial 1.8 mm microincision phacoemulsiflcation with conventional coaxial 3 mm small-incision cataract surgery.Methods A randomized prospective study was conducted on 89 patients with age-related cataract:coaxial 1.8 mm microincision cataract surgery ( MICS group) was performed in 45 cases (45 eyes),and coaxial 3 mm small incision cataract surgery (SICS group) was performed in 44 cases (44 eyes).Statistical analysis was taken with the data of 40 cases (40 eyes) in the MICS group and 40 cases (40 eyes) in the SICS group.The average ultrasound power (AVE) and effective phacoemulsification time (EPT) were recorded during the operation.Visual acuity,endothelial cell density and cornea thickness were compared at intervals of 1 day,1 week,1 month and 3 months after surgerf.In addition,surgically induced astigmatism (SIA) was analyzed.Statistic analysis was taken by student's t test and chi square test.Results There was no significant difference on AVE and EPT (P ＞ 0.05 ) between these two groups.One day after the surgery,the MICS group showed better uncorrected visual acuity (0.16 ±0.14) as compared to the SICS group (0.23± 0.12).The difference was statistically significant ( P ＜ 0.05 ).There were no significant differences on best corrected visual acuity,endothelial cell density and cornea thickness between these two groups.One week,1 month and 3 months after the surgery,SIA was (0.62 ± 0.28) D,(0.48 ± 0.28) D,(0.47 ±0.25) D,(0.40 ± 0.24) DintheMICSgroup,and(1.27 ± 0.65) D,(1.18 ± 0.59) D,(1.02 ±0.56) D,(0.79 ± 0.48) D in the SICS group,respectively.The differences between the MIC and SICS groups were statistically significant (P ＜0.01 ).SIA decreased significantly and became stable 1 week after surgery in MICS group,while the similar tendency appeared one month after the surgery in the SICS group.Conclusions Coaxial 1.8 mm microincision cataract surgery could significantly reduce SIA and obtain more stable astigmatism status.This suggests that the coaxial MICS phacoemulsification surgery could get earlier visual rehabilitation postoperatively.